Medical residents coming out of the nation's healthcare institutions are well-skilled in hospital settings but require training and education in other key areas of practice in the 21st century.
That was the conclusion of Dr. Francis “Jay” Crosson, senior medical director of the Permanente Foundation at Kaiser Permanente, who participated in a panel discussion on the future of the healthcare workforce at AcademyHealth's national policy conference in Washington.
Crosson, who formerly served on the Medicare Payment Advisory Commission, cited some areas where residents need preparation, such as office-based care competencies, care coordination, continuity of care, “systems” thinking, and leadership and management skills, the last of which would help residents learn how to run a project or meeting, how to speak in public and how to mentor others.
“Which of these can we expect from residency programs, and what is naturally on-the-job training?” Crosson asked, adding that he hopes Congress will appropriate funding for the National Health Care Workforce Commission, which was established in the Patient Protection and Affordable Care Act.
Fellow panelist Mary Wakefield, administrator of HHS' Health Resources and Services Administration, said the HRSA has about 50 provisions to implement related to the Affordable Care Act, many of which are directed toward workforce issues. In administering to a country that has a growing overall population and aging population—as well as more insured individuals because of the 2010 law—the HRSA needs to “re-set the workforce trajectory,” Wakefield said.
Its multi-pronged strategy to do this includes providing analysis through a new workforce analytic center to identify needs and priorities; increasing the number of primary-care providers; investing in high-quality, cutting-edge training; and deploying providers to underserved areas. The Affordable Care Act made available more than $455 million to support the training of about 2,300 new primary-care providers by 2015, and by the end of January 2011, the HRSA had awarded more than $270 million through the act, according to the agency.
AcademyHealth, which promotes health research and policy, started its two-day conference Monday with remarks from CMS Administrator Donald Berwick, who reiterated his agency's “three-part aim” of bettering health for populations, bettering care for individuals and lowering costs through improvement. Berwick also challenged his audience of researchers to consider a series of questions he would like to see answered, including: What are the extent and forms of waste in healthcare? What forms of integrated care work well for various contexts and local circumstances? And how can total cost be known and tracked at the population level?
After his remarks, Berwick spoke briefly with reporters and answered a question about guidance for the nation's healthcare providers who are working on provisions of the Affordable Care Act amid uncertainty on Capitol Hill and in the courts.
“Stay with it,” Berwick said. “We need implementation.”
